Provider Demographics
NPI:1134379902
Name:GRAHAM, DAVID ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6536 ANTHONY DR STE C
Mailing Address - Street 2:SUITE C
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1419
Mailing Address - Country:US
Mailing Address - Phone:585-300-4575
Mailing Address - Fax:585-300-0703
Practice Address - Street 1:6536 ANTHONY DR STE C
Practice Address - Street 2:SUITE C
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1419
Practice Address - Country:US
Practice Address - Phone:585-300-4575
Practice Address - Fax:585-300-0703
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2016-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2692552082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery